Pharmacists Future Contribution to Health Care

Prof Charlie BenrimojPro-Vice Chancellor (Strategic Planning) & Prof of Pharmacy

PracticeFaculty of Pharmacy

Peppers Salt Resort Sept 2006

Practical Application for Pharmacy

• Where will your business be in 5 to 10 years time ?

• Where will your professional practice be in 5 to 10 years time ?

• Hypothesis: Commercial and professional future of pharmacy dependant of future of health care

Change of Retail Philosophy inFront of Shop – lack of strategic

approach

• Cosmetic retailing improvements have occurred but not the underlying mix of products and approach– Low cost lowest price etc

– Volumes protected by PBS growth and monopoly of S2/S3

Change of Philosophy in Front of shop

• Intellectually stagnant for decades

• Improvements on old models of retailing

• Copying of retail models – is that appropriate ??

I

Value Proposition for Community Pharmacy – Global

Pharmacy to Optimize its value to the health (wellness) and disease (quality of life) of the community

Predict Future of Health ?

• Based on– Existing knowledge and trends– International health systems– Australian health care systems– Australian population– Major demographic changes– Major disease changes– Major service changes

• High Probability

The Shape of Our Future – Change management project (RFT 2003 -06)

• Uptake of prevention and self-management

•Changing community expectations

•New technology•Costs•Safety and quality

•Demography•Disease patterns•Changing health needs of the population

•Management of the system

•Use of ICT

TOP 10 Predictions

Future Certainties: Disease Patterns

Multiple disease states Disease changing definition Increased medication as a treatment modality Better detection of disease and risk factors

e.g. Diabetes Prevalence: 3.4% (1981) to 7.2% (1999-2000)

Underlying trends in risk factors (obesity, physical inactivity, impaired glucose tolerance)

Better management leading to longer survival

Source: AIHW (2004). Australia’s Health. Canberra: AIHW

Changing Community Expectations

• Increased demand for health information• Living longer with chronic disease

– Wish to have control over their life– Increased involvement in decision making

( evidence based)– Expert in dealing with disease– More than one health care practitioner

• Accessibility – more choice and flexibility

Demographic Changes & Disease Patterns & Consumer expectations

• No of people with complex chronic disease will increase.• Many will be elderly and have multiple health problems• Shift to self management• Involved in decision making• Increase to health promotion and disease prevention

(increased demand for screening)• Increased demand for access to health services at

convenient locations and at times that do not clash with work, educational or domestic responsibilities

• Increased safety and quality

Safety and Quality

• “Simply being a patient in an acute care hospital in Australia on average a 40 fold increase greater risk of dying for the care process than from being in traffic.” (1)

• Probably safer to travel by plane than to enter hospital due to systems

• Serious deficiencies in Hospital and Aged care system– 1/6th associated with adverse events, during or

before hospital stay (2)

• Drug related problems in Community

(1) Australian patient safety foundation 2001 (2) Wilson et al 1999

Detection of Drug Related Problems

Range of Interventions or drug related problems

CMI

Clinical Interventions

Domiciliary Medication Management Reviews

Residential Medication Management Reviews

Disease State Management

S2 and S3 Pharmacy Medicines

Major Business and Professional Opportunity

• Increased medicine usage and service requirements as result of increase prevalence of chronic disease and age of population

• Better Quality Control Systems• Different type of consumer due to increase

in self management and decision making• Increased specialization

– Businesses market niche– Professional Practice

Critical Questions

• How have we reacted ?

• Are we passive or creating our future ?

• Are we adapting out retailing and positioning our business?

• Are we evolving professionally ?

How have we reacted so far ?

• Predominantly two trends– Guild government agreements– Banner group development by wholesalers– Banner group developments by independents– Individual practitioners “innovators”

• LACKING SYSTEMATIC APPROACH

Professional Services 2000-10• Medication information (CMI) 3• Clinical interventions (DRG) • Abridged review in pharmacy (4)• Administration aids (4)• Residential medication reviews (RMMR) 2• Domiciliary medication reviews (HMR/DMMR) 3• Disease state management (DSM) 4• GP pharmacist in surgeries • Specialist CPS areas – e.g. mental health, genomics,

genetics• Pharmacist Prescribing

No. Guild/Government agreements

Translating the Value into Business Proposition

• Service delivery to:

CMI – users of medications

HMMR – 5 prescription items or more

DSM – chronic users of medications

QCPP – quality of infrastructureHigh expenditure consumers

Customer loyalty - Increase traffic flow

Product mix in front of shop

PBS and Health position

Future HealthCertainties

Changes in health

care

Opportunities for

community pharmacy

Selectopportunities

Characterizeopportunities

Consequencefor

Pharmacyand

others

Systematic Approach

Combined

In spectrum of

health care

In spectrum of

client/ professional

engagement

In spectrum of

service type

Community

pharmacy’s

professional role

Service setting Resources

Prevention

Early detection

Diagnosis and

assessment

Treatment

Rehabilitation

Palliation

Self- care

Service delivery

Retail

Professional

Novel service

being provided

by community

pharmacy

Supplementation

by community

pharmacy of

service provided

by others

Substitution by

community

pharmacy of

service hitherto

provided by

others

Options include:

1. Shop

2. Other

professional

premises

3. Mixed (1) & (2)

pharm only

4. With other

professionals

(1)- (3)

5. Patient’s home

6. Nursing home

7. Others

Skills

1. Basic

education

2. Continuing

education

3. Training

Incentives

Infrastructure

Frommer, Roberts and Benrimoj 2004

1. Spectrum Of Health Care

•Prevention •Early Detection Diagnoses and Assessment

•Treatment•Rehabilitation•Palliation

2. Spectrum of Engagement

SelfManagement

ProfessionalCare

Delivery

3 & 4 Pharmacy Activity and Remuneration

ProductSupply

Service

Consumerpayment

ProductAnd

Service

Governmentpayment

Health insurancePayment

Any Combination

Community Pharmacy & Pharmacist Roles

Supplementationof Service by

other Provider

Loss of RoleRegaining Role

previously Taken by Others

Novel Serviceor Product

Substitutionof Service provided

by Others

eg Immunization

eg HMR

eg Diabetes education

eg Nutritioneg Herbal medicines

Service Setting

Retail

OtherProfessional

Premises

Patients Home Nursing Home

E- Pharmacy

Schematic ViewDispensary - Prescriptions Pharmacy Only and

Pharmacist Only products (Primary Care)

Departments or Categories, Health and beauty

Philosophy - Strategic Framework• Dispensary (chronic diseases)• Pharmacy Only and Pharmacist Only

products (Primary Care)• Front of shop (prevention and

wellness)

Outcome: increase revenues and reverse trend on governmental dependence with mix of product and services

INTEGRATIon

Pharmacy Viability Matrix

Focused Specialities Multi Specialties

Traditional Pharmacy Pharmaceutical Superstore

COMMUNITY SCOPE

EXTENDED

LOCAL

NARROW BROAD

PRODUCT/SERVICE CHOICE

Core Pharmacy Product & Service

The Shape of Our Future – Change management project (RFT 2003 -06)

Traditional Pharmacy

Focused Specialties Multi specialties

Traditional Pharmacy

e.g. UTS pharmacyPharmaceuticalSuperstore

COMMUNITY SCOPE

LOCAL

Traditional Pharmacy

Provides local consumers with a focused supply of traditional pharmacy products and/or services. They are the front-line of health care within their community

NARROW BROAD

CUSTOMER PRODUCT/SERVICE CHOICE

EXTENDED

Specialties

e.g. compounding Multi Specialties

Traditional Pharmacy PharmaceuticalSuperstore

LOCAL

Focused Specialties

Provide a small number of specialised and alternative products and/or services to a focused niche “patient” market that extends beyond their local community.

NARROW BROAD

CUSTOMER PRODUCT/SERVICE CHOICE

EXTENDED

COMMUNITY SCOPE

Focused SpecialtiesMulti-service specialties

e.g. Fresh Therapeutics E-Pharmacy

Traditional Pharmacy PharmaceuticalSuperstore

COMMUNITY SCOPE

EXTENDED

LOCAL

Multi Specialties

Offer a range of highly specialised health-care solutions to an extended market. These products and/or services are not “generic” and their product and/or service range is difficult to imitate.

NARROW BROAD

CUSTOMER PRODUCT/SERVICE CHOICE

Conclusion - Future

• Great opportunities in Health Care for Pharmacists and Pharmacy

• Rate of Change is the question moving from old traditional ways of retailing to more sophisticated approaches

• Retailing of Goods to Retailing of Goods and Services